Saddle embolus with right heart strain

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Shortness of breath.

Patient Data

Age: 50 years
Gender: Male
  • intra-luminal filling defect straddles the pulmonary artery trunk bifurcation and extending into the main right and left pulmonary arteries in keeping with saddle thrombus

  • multiple bilateral filling defects (emboli) are noted in the lobar, segmental and subsegmental branches of th pulmonary arteries

  • Signs of right heart strain

    • enlargement of the pulmonary trunk (bigger than the aorta)

    • enlargement of the right ventricle (bigger than the left ventricle)

    • flattening of the interventricular septum

  • minimal pleural effusion

  • both lungs are clear

Case Discussion

CTA features of saddle pulmonary embolism with right heart strain.

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